الفهرس 
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Abstract
Summary
Enteral feeding or enteral nutrition (EN) is preferable route and utilized commonly for nutritional support in critically ill patients. In spite of simplicity of giving enteral feeding via nasogastric tube, it is associated with serious gastrointestinal complications. Abdominal massage was considered a nursing intervention for minimizing elevated gastric residual, vomiting frequency, constipation and abdominal distension as has been indicated in numerous studies. Abdominal massage shortens the time it takes for food to pass through the digestive tract, stimulates and preserves peristaltic activity, and decreases intra-abdominal pressure (Diab et al., 2021).
Aim of the Study:
This study aimed to evaluate the effect of abdominal massage on gastrointestinal outcomes among intermittent enterally fed critically ill patients through the following:
1. Assessment of the patients for gastrointestinal outcomes among intermittent enterally fed critically ill patients.
2. Implementing abdominal massage on intermittent enterally fed critically ill patients.
3. Evaluating the effect of the abdominal massage on gastrointestinal outcomes among intermittent enterally fed critically ill patients.
Research Hypotheses:
The current study hypothesized that:
H1: The study group who receive abdominal massage will have better gastrointestinal outcomes regarding gastric residual volume than the control group.
H2: The study group who receive abdominal massage will have better gastrointestinal outcomes regarding abdominal distension than the control group.
H3: The study group who receive abdominal massage will have better gastrointestinal outcomes regarding vomiting than the control group.
H4: The study group who receive abdominal massage will have better gastrointestinal outcomes regarding intra-abdominal pressure than the control group.
H5: The study group who receive abdominal massage will have better gastrointestinal outcomes regarding constipation than the control group.
Research Design:
Quasi-experimental design (study & control; pre & post test) used in carrying out this study to evaluate the effect of abdominal massage (independent variable) on gastrointestinal outcomes (dependent variables) among intermittent enterally fed critically ill patients.
Research Setting:
This study was conducted at the General Intensive Care Unit (ICU) at El Fayoum University Hospital, El Fayoum, Egypt. This ICU located at 2nd floor in the hospital with total capacity of 36 beds, 20 ventilators, 36 monitors and 5 emergency carts, it were distributed in 11 rooms, ICU also contains three rooms for medication and supplies storage.
Research Subjects:
A Purposive sample of 110 critically ill patients who met the inclusion criteria at previously mentioned setting, and they would be enrolled sequentially into two groups (study and control group); each group consisted of 55 patients. Sample size was calculated statistically by power analysis considering the total number of critically ill patients admitted to El Fayoum university hospital during the year (2019).
Inclusion criteria:
The inclusion criteria of the current study includes adult patients from both gender >20 years old, patients with newly inserted nasogastric tube for intermittent enteral feeding, patients who have indwelling urinary catheter for measuring intraabdominal pressure, hemodynamically stable, free from intestinal obstruction and didn’t have contraindications to abdominal massage such as diarrhea, active bleeding, spinal cord injury or recent abdominal surgery.
Exclusion criteria:
The exclusion criteria of the current study includes patients receiving prokinetic medications as metoclopramide (reglan) and cisapride (propulsid) to avoid interfering with the massage effects, patients with hepatic impairment and abdominal aortic aneurysm and patients who was receiving radiotherapy or chemotherapy.
Tools of data collection:
Two main tools were used for data collection
Tool (I): Patients’ assessment tool:
This tool is consisted of three parts:
• Part (I): Demographic data.
• Part (II): Clinical data.
• Part (III): Enteral feeding data.
Tool (II) Gastrointestinal outcomes assessment tool:
This tool is consisted of five parts:
• Part (I): Gastric residual volume.
• Part (II): Abdominal distension.
• Part (III): Vomiting.
• Part (IV): Intra-abdominal pressure.
• Part (V): Constipation.
The main findings of the current study can be summarized in the followings:
• The mean scores of gastric residual volume in the study group subjects was 8.329.17 ml versus the mean score of the control group subjects was 33.8211.71 ml with highly statistically significant difference between both groups at P.value 0.00000 in the fifth day post implementation of abdominal massage.
• 16.37% of the study group subjects compared to 69.09% of the control group subjects had abdominal distension with highly statistically significant differences between both groups at P.value 0.00000 in the fifth day post implementation of abdominal massage.
• Frequency of vomiting episodes after meal in the study group subjects was 7.27% and in the control group subjects was 16.36% with no statistically significant differences between both groups at P.value > 0.05 in the fifth day post implementation of abdominal massage.
• The mean scores of intra-abdominal pressure for the study group subjects was 7.673.00 mmHg and the mean score of the control group subjects was 13.214.15 mmHg with highly statistically significant differences between both groups at P.value 0.00000 in the fifth day post implementation of abdominal massage.
• Constipation occurrence in the study group subjects was 14.55% compared to 58.18% in the control group subjects with highly statistically significant difference between both groups at P.value 0.00000 in the fifth day post implementation of abdominal massage.
• Regarding vital signs, there were highly statistically significant differences between the study and control group subjects regarding respiratory rate and systolic blood pressure at P.value <0.001in the fifth day post implementation of abdominal massage.
Conclusion
Based on the results of the current study, it can be concluded that.
Abdominal massage was an effective intervention on the gastrointestinal outcomes among intermittent enterally fed critically ill patients as it leads to reduction in gastric residual volume, abdominal distension, intra-abdominal pressure and constipation. Furthermore, it helps in improvement of patients’ physiological parameters as respiratory rate and systolic blood pressure.
Finally, the present study concluded that the study group subjects who received abdominal massage had better gastrointestinal outcomes namely gastric residual volume, abdominal distension, intra-abdominal pressure and constipation and physiological parameters namely respiratory rate and systolic blood pressure than the control group subjects.
Recommendations
Based on results of the present study, the following recommendations could be suggested:
Regarding nursing education
• On-going and regular in-service educational programs about assessment of gastrointestinal outcomes among enterally fed critically ill patients and how to measure gastric residual volume and intra-abdominal pressure.
• On-going and regular in-service educational programs about abdominal massage as a non-pharmacological method to enhance feeding tolerance and gastric motility for enterally fed critically ill patients.
Regarding clinical practice:
• Incorporate abdominal massage as a routine nursing care for critically ill patients receiving enteral feeding.
• Gastric residual volume should be checked before enteral feeding for all critically ill patients.
Regarding further researches:
• Replication of this study on a larger probability sample to ensure generalizability of findings.
• Further researches are needed for assessing critical care nurses performance regarding abdominal massage among enterally fed critically ill patients.